Individual
CHESTER WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5950 METRO WAY SW, WYOMING, MI 49519-9514
(616) 252-8180
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
01064288A
IN
2085R0001X
Radiation Oncology Physician
Primary
4301508350
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548245712
—
MI
05
—
200882630
—
IN
Enumeration date
12/09/2005
Last updated
10/25/2023
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